Acutal pelvic inflammatory disease
Acute inflammation of the fallopian tube (tuba uterina) and/or the ovary (ovary) is called pelvic inflammatory disease (pelvic inflammatory disease) and is characterized by sudden onset of severe lower abdominal pain. This pain can be unilateral or bilateral, as the inflammation can also be unilateral or bilateral. In addition, vomiting, fever and signs of intestinal obstruction (ileus symptoms) can also occur.
Acute pelvic inflammatory disease can cause a medical emergency in the form of a so-called acute abdomen and should therefore be detected and treated quickly. In addition, acute pelvic inflammatory disease caused by certain pathogens (chlamydia) can lead to an additional inflammation of the liver (Fritz-Hugh-Curtis syndrome) with right-sided pain in the upper abdomen and an increase in liver values. If the acute pelvic inflammatory disease is not treated early and adequately, it can develop into a so-called chronic pelvic inflammatory disease.
Most patients suffer from chronic pelvic pain throughout their lives, but it is much less severe and less frequent. The causes of acutal pelvic inflammatory disease are usually ascending germs which, especially in sexually active women, enter through the vagina and then migrate towards the fallopian tubes and ovaries. Only rarely are there descending (descending) infections, which are caused by appendicitis, peritonitis or a chronic inflammatory bowel disease such as Crohn’s disease.
In most cases, the pathogens are so-called chlamydia (approx. 26%) or the bacteria causing gonorrhoea (Neisseria gonorrhoea) (approx. 29%), although many more pathogens are possible.
Adnexitis acuta requires a more rapid and invasive diagnosis than would be the case with chronic adnexitis. If no cause can be found by clinical examination in the form of a palpation, by the so-called speculum adjustment including microbiological smears and by ultrasound examination (sonography), laparoscopy (laparoscopy) or the so-called pelviscopy (pelviscopy) with microbiological smears is used earlier than diagnostic procedures. Once the diagnosis has been confirmed, antibiotic treatment should be started as early as possible, which should be directed specifically against the germ causing the disease.
In addition, some patients also require surgical intervention to relieve the accumulation of pus (abscesses). Painkillers can also be administered to reduce the pain. As a rule, acute pelvic inflammatory disease requires hospitalisation.
Infertility due to an adnexitis
An adnexitis can also become chronic, i.e. it can turn into a permanent disease. A complication of both acute and chronic pelvic inflammatory disease can be infertility. This is caused by the organ becoming sticky.
The inflammatory fluid, pus and blood, which are produced as a result of the inflammation, lead to fibrinisation and thus to the organ becoming sticky. In this case the ovaries and fallopian tubes. The aim of the therapy is to maintain the fallopian tubes in their complete function and thus the fertility of the woman.
Therefore, antibiotic therapy is started immediately after taking the smear. This takes place directly into the vein for 10 days, which is why an inpatient stay in hospital is necessary. Bed rest is recommended, especially at the beginning of the disease.
Sick women should drink enough fluids, have regular bowel movements and urinate. Especially in the acute phase, additional pain medication can be given to improve the patient’s general condition. The painkillers administered also counteract the inflammatory process.
During the phase of the acute illness, sexual intercourse should be avoided if possible. Supporting physical therapy is started. Here, hourly cooling during the acute phase of the disease leads to reduced blood circulation and thus to a reduced spread of the inflammation.
Later, after the acute symptoms are over, the blood circulation should be increased with the help of warm and moist compresses to counteract adhesions. An operation is only necessary if the acute inflammation affects other organs, such as the appendix (appendicitis) or the peritoneum (peritoneum). Fluids (abscesses) may also have accumulated in the peritoneal cavity, especially between the uterus and rectum (Douglas cavity).
These must be punctured. If a stuck fallopian tube and adhesions still exist after the therapy, an operation is the only way to restore fertility or eliminate infertility. In this procedure, the adhesions are removed and the opening of the fallopian tube is made continuous again.
Since a bacterial infection can be treated most effectively with an antibiotic, an antibiotic is recommended for every case of pelvic inflammation. In difficult cases it is even necessary to administer the antibiotic through a vein in order to fight the inflammation sufficiently. This is important so that the inflammation does not spread further to the abdomen or cause sepsis (blood poisoning).
Which antibiotic is best to treat an adnexitis depends on the bacterium that caused the inflammation. This is because the various antibiotics each specialise in specific bacteria. To find out which bacterium it is, a sample is taken and microbiologically examined.
Since this examination can take a few days, the first step is to treat the bacteria with a broad-spectrum antibiotic. Ciprofloxacin and metronidazole are often used. These antibiotics can fight many possible bacteria. If it has been proven that the bacteria are gonococci, it is recommended to give additional ceftriaxone. In the case of inflammation with chlamydia, azithromycin is also recommended.